Dual Eligible Home and Community-Based Waiver Program Participants and the New Medicare Drug Benefit

Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan.

This paper offers state and federal policymakers ideas for what to monitor to ensure that waiver participants maintain equal access to prescription drugs as their institutionalized peers, and can remain in waiver programs without increased physical harm or financial hardship